CIHM 
Microfiche 
Series 
(IMonog  raphe) 


ICMH 

Collection  de 
microfiches 
(monographies) 


Canadian  Instituta  for  Historical  Mieroraproductiona  /  Institut  Canadian  da  microraproductiona  liistoriquaa 


Tachnicai  and  Bibliographic  Notaa/Notas  tachniquaa  at  bibliographiquaa 


Tha  Inttituta  haa  attamptad  to  obtain  tho  boat 
original  copy  avaiiabia  for  filming.  Faaturaa  of  thia 
copy  which  may  ba  bibliographically  uniqua. 
which  may  altar  any  of  tha  imagaa  in  tha 
raproduction,  or  which  may  significantly  changa 
tha  uaual  mathod  of  filming,  ara  chackad  balow. 


□    Colourad  covara/ 
Couvartura  da  couiaur 

□   Covars  damagad/ 
Couvartura  andommagia 

□   Covars  rastorad  and/or  laminatad/ 
Couvartura  rastaur*«  at/ou  pallicuMa 

□    Covar  titia  missing/ 
La  titra  da  couvartura  manqua 


D 

D 


Colourad  mapa/ 

Cartas  gAographiquas  an  couiaur 

Colourad  ink  (i.a.  othar  than  blua  or  black)/ 
Encra  da  couiaur  (i.a.  autra  qua  blaua  ou  noiral 

Colourad  platas  and/or  illustrations/ 
Planchas  at/ou  illustrations  an  couiaur 


Bound  with  othar  matarial/ 
Rali*  avac  d'autras  documants 


0 


FT]    Tight  binding  may  causa  shadows  or  distortion 


n 


D 


along  intarior  margin/ 

La  rt  liura  sarrte  paut  causar  da  I'ombra  ou  da  la 

distorsion  l«  long  da  la  marga  intiriaura 

Blank  laavas  addad  during  rastoration  may 
appaar  within  tha  taxt.  Whanavar  possibla.  thasa 
hava  baan  omittad  from  filming/ 
II  sa  paut  qua  cartainas  pagaa  blanchas  ajouttoa 
lors  d'una  rastau  ration  apparaissant  dans  la  taxta. 
mais,  lorsqua  caia  Atait  possibla.  cas  pagas  n'ont 
paa  *t*  filmias. 

Additional  commants:/ 
Commantairas  supplAmantairas: 


L'Instttut  a  microfilm*  la  maillaur  axamplaira 
qu'il  lui  a  it*  possibla  da  sa  procurar.  Las  details 
da  cat  axamplaira  qui  sont  paut-4tra  uniquas  du 
point  da  vua  bibliographiqua.  qui  pauvant  modifiar 
una  imaga  raproduita.  ou  qui  pauvant  axigar  una 
modification  dans  la  mithoda  normaia  da  filmaga 
sent  indiquis  ci-dassous. 


□   Colourad  pagas/ 
Pagaa  da  couiaur 

ry\    Pagaa  damagad/ 


D 


Pagas  andommagAas 

Pagas  rastorad  and/or  laminatad/ 
Pagas  rastai ■<■->■    *;   yi  palliculAas 


Pagas  discci 


'.\  inad  or  foxad/ 
tach<>t*as  ou  piquAas 


[^    Pagas  d*colc 

Pagas  datach 
Pagas  ditachaas 

Showthrough 
Transparanca 

Quality  of  prii 

Qualiti  inAgala  da  I'imprassion 

Includas  supplamantary  matarii 
Comprand  du  material  suppl^mantaira 

Only  adition  avaiiabia/ 
Saula  Adition  disponibia 


I      I  Pagas  datachad. 

r~71  Showthrough/ 

FTI  Quality  of  print  varias/ 

I      I  Includas  supplamantary  matarial/ 

r~~|  Only  adition  avaiiabia/ 


n 


Pages  wholly  or  partially  obscurad  by  errata 
slips,  tissues,  etc..  hava  baan  refilmed  to 
ensure  the  best  possible  image/ 
Les  pages  totalement  ou  partiallement 
obscurcies  par  un  fauillet  d'errata.  una  pelure. 
etc..  ont  M  filmies  A  nouveau  da  facon  A 
obtanir  la  mailleura  image  possible. 


This  item  is  filmed  at  tha  reduction  ratio  chackad  below/ 

Ce  document  est  filmA  au  taux  da  reduction  indiqu*  ci-dassous. 


10X 

14X 

18X 

22X 

2SX 

30X 

/ 

i 
1 

12X 


1«X 


aox 


a4x 


2BX 


32X 


Th«  copy  fllmad  her*  has  baan  raproduead  thank* 
to  tha  ganarosfty  of: 

Unhrtnity  of  Tonmto  Lltrary 


L'axamplaira  film*  fut  raproduit  grica  *  la 
g«n«roait«  da: 

Univwnity  of  Toronto  Library 


Th*  imagas  appaaring  hara  ara  tha  bast  quality 
ponibia  contidarirtg  tha  condition  and  lagibiiity 
of  tlM  original  copy  and  in  kaaping  with  tha 
filming  contract  spaclfications. 


Original  copias  In  printad  papar  covart  ara  filmad 
baginning  with  tha  front  covar  and  anding  on 
ttia  last  paga  with  a  printad  or  illustratad  impras- 
ston,  or  tha  back  covar  wtian  approprlata.  All 
othar  original  copias  ara  filmad  baginning  on  tha 
first  paga  with  a  printad  or  Illustratad  impras- 
sion.  and  anding  on  tlia  last  paga  with  a  printad 
or  illustratad  imprasston. 


Tha  last  racordad  frama  on  aach  microflcha 
shall  contain  tha  symbol  '^^  (maaning  "CON- 
TINUED"), or  tha  symbol  ▼  (maaning  "END"), 
whichavar  applias. 


Las  imagas  suivantas  ont  4t«  raprodultas  avac  la 
plus  grand  soin.  compta  tanu  da  la  condition  at 
da  la  nattat*  da  Taxamplaira  film*,  at  an 
conformity  avac  las  conditions  du  contrat  da 
filmaga. 

Las  axampWras  orlglnaux  dont  la  eouvartura  an 
papiar  ast  ImprimAa  sont  filmte  an  comman^nt 
par  la  pramlar  plat  at  an  tarmlnant  soit  par  la 
darnlAra  paga  qui  comporta  una  amprainta 
d'Imprasslon  ou  d'lllustration,  soit  par  la  sacond 
plat,  salon  la  cas.  Tous  las  autras  axamplalras 
orlginaux  sont  flimte  an  commandant  par  la 
pramiira  paga  qui  comporta  una  amprainta 
d'Imprasslon  ou  dlllustration  at  an  tarmlnant  par 
la  damlAra  paga  qui  comporta  una  talla 
amprainta. 

Un  das  symbolas  suivants  apparattra  sur  la 
daml*ra  imaga  da  chaqua  microflcha,  salon  la 
cas:  la  symbola  — ^  signlfia  "A  SUIVRE",  la 
symbols  ▼  signlfia  "FIN". 


Maps,  platas.  charts,  ate.,  may  ba  'ilmad  at 
diffarant  raduction  ratios.  Thosa  too  larga  to  ba 
antiraly  Includad  in  ona  axposura  ara  filmad 
baginning  in  tha  uppar  laft  hand  comar,  laft  to 
right  and  top  to  bottom,  as  many  framas  as 
raqulrad.  Tha  following  diagrams  illustrata  tha 
mathod: 


Las  cartas,  planehas.  taUaaux.  ate.  pauvant  Atra 
filmte  A  das  taux  da  rMuction  diffArants. 
Lorsqua  la  documant  ast  trop  grand  pour  Atra 
raproduit  an  un  saul  cllchA.  II  ast  fHmA  A  partir 
da  I'angla  supAriaur  gaucha.  da  gaucha  A  droha. 
at  da  haut  an  has,  an  pranant  la  nombra 
d'imagas  nAcassaira.  Las  diagrammas  suhrants 
lilustrant  la  mAthoda. 


1 

2 

3 

1 

2 

3 

4 

5 

6 

nMoraoorr  MntunoN  tbt  chait 

(ANSI  and  ISO  TEST  CHART  No.  3) 


1.0 


1.1 


Itt 


U 


112 


116 


1*0 


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l^b^ij^ 


A 


/^PR.ED  I^MGE    Ine 


l«M  cm  IMn  SfMI 


(7t«)  4«a  -  0300  -  Finn* 


(7I0); 


-Fan 


What  is  the  "Cause"  of 
Disability? 


BY 


WILLIAM  RENWICK  RIDDELL,  LL.D^ 

imtONTO, 
FEIXOW.   »OVAI.  HISTORICAL   SOCTETY,   ETC. 


Rcfrintcd  from  The  New  York  Medkal  Journal  for 
January  13,  igj/. 


1 

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1 

II 

1 

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Reprinted  from  the  New  York  Medical  Journal  for 
January  is,  1917. 


WHAT  IS  THE  "CAUSE"  OF  DISABILITY? 
A  Medici^egal  Question, 

By  Wizxiam  Renwick  Riddell,  LL.D.,  Etc., 
Toronto,  Ont 

In  the  Supreme  Court  of  Ontario,  a  medicolegal 
case  has  recently  been  decided  which  will  be  of  in- 
terest to  many  medical  men. 

Doctor  Mitchell  took  out  an  accident  insurance 
policy  in  the  Fidelity  and  Casualty  Company  of 
New  Yoric ;  a  few  days  thereafter,  he  was  thrown 
from  his  berth  in  a  Pulhnan  car  and  sprained  his 
wrist.  The  injury  did  not  improve  as  expected  ow- 
ing to  tuberculous  infection ;  and  it  appeared  to  be 
permanent.  The  policy  called  for  $150  a  week  for 
total  disability,  "however  long  continued,  if  resulting 
from  accident  directly,  independently,  and  exclu- 
sively of  all  other  causes" ;  the  company  held  that 
the  accident  was  not  the  <Mily  cause  and  refused  to 
pay.  Doctor  Mitchell  sued  and  succeeded  at  the 
trial.  The  matter  came  to  be  decided  in  the  Ap- 
pellate Division  of  the  Supreme  Court,  of  which  I 
have  the  honor  to  be  a  member. 

I  add  here  so  much  of  my  judgment  as  is  not  of 
interest  to  lawyers  only : 

"Riddell,  J. : — ^This  appeal  involves  the  interpreta- 
tion of  a  contract  of  veiy  common  occurrence.  Were 
it  a  case  of  less  importance,  I  should  be  content  to 
adopt  without  further  comment  the  conclusions  of 
the  learned  trial  judge,  and  so  dismiss  this  appeal. 

But  the  advance  of  knowledge  raises  and  will  con- 
tinue to  raise  novel  contention  :  and  what  is  a  com- 
monplace at  one  time  becomes  a  matter  of  great  con- 
troversy at  another.  Until  very  recently,  the  main 
ground  of  dispute  of  liability  here  would  not  have 
been  thought  of:  or,  if  thought  of,  would  have  re- 

Copyright,  1917,  by  A.  R.  Elliott  Publiibinc  Comowiy. 


Riddell:    A  Cauu  of  Ditability. 


,;  i 


ceived  scant  consideration— but  tempora  mutantur  it 
nos  mittamur  in  Mis.  •  .•  »  • 

The  plaintiff,  a  doctor  of  mediane,  a  specialist  m 
diseases  of  the  eye,  ear,  noM,  and  throat,  took  out 
an  accident  policy  with  the  defendants,  an  accident 
insurance  company.  In  most  accident  insurance  pol- 
icies, the  beneficiary  is  entiUed  to  payment  only  for 
a  limited  time  (usually  on.  year  or  less),  but  this 
company  finds  its  account  in  making  its  policies  per- 
petual, that  is,  for  the  Ufe  of  the  patron  who  may 
be  injured.  No  doubt,  tliis  forms  a  strong  induce- 
ment to  those  desiring  accident  insurance,  to  prefer 
ihiit  company. 

In  the  appUcation,  the  duties  of  his  occupation  are 
described  as  "special  work  on  eye,  ear,  nose,  and 
throat,"  and  the  insurance  was  against  "bodily  injury 
sustained  .  .  .  through  accidental  means  .  .  .  and 
resulting  directly,  independently,  and  exclusively  of 
all  other  causes  in  an  immediate,  continuous,  and 
total  disability  that  prevents  the  insured  from  per- 
forming any  and  every  kind  of  duty  pertaining  to 
his  occupation." 

The  plaintiff  was  thrown  from  an  upper  berth  i.. 
a  sleeping  car  and  thereby  sprained  his  wrist 
severely — it  is  not  contended  by  the  defendants  that 
this  was  not  an  injury  within  the  meaning  of  the 
policy— and,  had  the  injury  healed  within  a  short 
time,  no  doubt  the  company  would  have  paid  the 
$150  per  week  without  demur. 

But  the  injury  did  not  heal,  it  is  not  yet  healed, 
and  It  is  doubtful  whether  it  will  ever  be  much  im- 
proved—the company  find  themselves  charged  with 
an  obligation  to  pay  $150  per  week  for  years,  per- 
haps until  the  death  of  the  plaintiff;  and  hence, they 
dispute  liability. 

Several  medical  men  of  eminence  were  examined 
at  the  trial:  without  at  all  reflecting  on  any  other, 
it  seems  to  me  that  the  evidence  of  Doctor  Anderson 
gives  the  mosi  satisfactory  explanation.  He  says 
that  some  time  ago,  probably  some  ten  or  fifteen 
years  before  the  accident,  there  had  been  a  tuber- 


Riddell:   A  Cautt  of  DtMbilily. 

culous  condition  of  part  of  the  pleura,  protably 
the  apex  of  the  left  lung:  any  existing  tuberculous 
mass  had  become  encysted  so  as  to  leave  no  apparent 
disease— the  patient  would  be  quite  well,  whdly  un- 
conscious of  any  trtmUe,  danger,  or  disease;  and 
there  would  be  no  danger  of  another  outbreak  pro- 
ceeding from  the  original  disease. 

But  an  accident  happens,  tissues  are  injured,  a 
lessened  resistance  to  the  "germs"  occurs,  these, 
otherwise  innocuous,  find  a  ludus  into  which  to  in- 
trude and  in  which  to  become  active. 

I  can  see  no  difference  b^een  this  case  and  the 
case  of  an  injury  causing  a  break  in  the  skin  and 
thereby  allowinr  some  of  the  germs  which  are 
(practically)  dways  and  everywhere  floating 
around,  to  enter  and  set  up  a  diseased  condition. 
How  is  a  "lessened  resistance"  of  tissues,  without 
a  breach  of  continuity  of  the  skin  allowing  germs 
which  may  be  in  the  Wood  to  enter  and  set  up  or 
continue  an  inflammatory  cemdition,  different  from 
a  lesion  of  the  skin  allowing  similar  germs  which 
may  be  in  the  air  to  enter  with  the  same  result? 

Until  a  comparatively  recent  day,  no  one  knew 
anything  about  the  tubercle  bacillus,  and  such  affec- 
tions as  are  now  known  (so  far  as  such  matters  are 
known)  to  be  due  to  the  invasion  of  a  bacillus  were 
supposed  to  be  due  to  exposure  to  the  air.  Would 
any  one  in  that  state  of  theory— knowledge  if  you 
will— say  that  the  air  was  a  contributing  cause  of 
the  disability  ?  And  is  the  meaning  of  words  to  be 
changed  by  the  change  of  medical  theory? 

We  must  interpret  this  document  on  common 
sense  principles ;  no  one  could,  when  obtaining  acci- 
dent insurance,  imagine  that  he  was  guaranteeing 
the  company  against  the  presence,  accidental  and 
temporary  or  otherwise,  of  tubercle  bacillus  or  any 
other  bacillus  or  spirillum  in  his  system.  We  must 
interpret  the  language  of  this  contract  in  its  ordi- 
nary and  popular  meaning — the  use  of  language 
preceded  scientific  investigation. 

That  this  disability  has  as  a  cause  the  accident. 


il 


^mmmmmm 


H 


RiddtU:   A  Cause  of  Disability. 

cannot  be  disputed.  In  a  well  known  Scottish  case 
a  miner  was,  by  reason  of  an  accident  to  a  pump, 
compelled  to  stand  for  some  time  in  cold  water,  ex- 
posed to  a  current  of  cold  air.  This  reduced  his 
vitality  and  permitted  the  pnexunococci  which  are 
(practically)  everywhere,  to  overcome  the  resistance 
of  the  tissues;  pneumonia  set  in  and  the  man  died. 
The  arbitrate  held  that  the  pneumonia  was  causei 
by  the  occurrence;  and,  of  the  seven  judges,  six 
agreed  with  him — one  onlv  thinking  that  there  must 
be  some  direct  lesion.  This  case  was  approved  in  a 
case  in  the  House  of  Lords.  A  miner  was  exposed 
to  a  cold  current  of  air  which  "brought  on  pneu- 
monia," and  it  was  held  that  the  death  was  the  re- 
sult of  the  exposure. 

I  do  not  know  of  any  difference  between  the  case 
of  a  tubercle  bacillus  infection  and  that  of  a  pneu- 
mpcoccus  infection — it  is  said  you  cannot  have  tu- 
berculosis without  the  former  or  pneumonia  with- 
out the  latter.  And  I  can  see  no  difference  in  law 
I  .ween  an  accident  weakening  the  power  of  resist- 
ance of  the  tissues  and  allowing  the  pneumococcus 
to  enter  and  an  accident  of  another  kind  weakening 
the  power  of  resistance  of  the  tissues  and  allowing 
the  tubercle  bacillus  to  enter— the  infection  of  either 
kind  could  not  fairly  be  called  a  cause  within  the 
meaning  of  Ais  policy. 

It  is  to  be  noticed  that  in  both  the  pneumonia 
cases,  the  pneumococci  did  not  enter  by  any  external 
lesion,  but  attacked  the  tissues  in  the  same  way  as 
the  bacillus  in  the  case  now  under  consideration. 

The  case  of  Brintons  Limited  v.  Turvey  contains 
much  of  value.  A  workman  engaged  in  sorting 
wool  contracted  anthrax,  which  caused  his  death. 
"According  to  the  medical  evidence  and  theoiy,"  an 
anthrax  bacillus  passed  into  his  eye,  thereby  infect- 
ing him  with  that  terrible  disease,  and  causing  his 
death.  The  County  Court  Judge  held  that  the  en- 
try of  the  bacillus  was  an  accident ;  his  decision  was 
affirmed  by  the  Court  of  Appeal  and  the  House  of 
Lords.    Lord  Halsbury  gives  examples  of  what  he 


RiddeU:   A  Cautt  of  DitahiHly. 

'•  .uld  call  accidents :  "A  workman  .  .  .  spills 
some  corrosive  acid  on  his  hands ;  the  injury  caused 
thereby  sets  t^>  erysipelas-  4  definite  disease:  some 
trifling  injury  by  a  needle  sets  up  tetanus."  No  one 
in  the  present  state  of  medical  science  doubts  that 
erysipelas  and  tetanus  are  germ  diseases  like  tuber- 
culosis, pnetunonia,  and  malaria. 

In  ."uiswer  to  the  argument  or  suggestion  that  the 
condition  of  the  plaintiff's  bodily  system  was  a  con- 
tributine  cause,  I  asked,  "Suppose  the  plaintiflF  were 
"a  bleeder' — of  the  hemo  rhagic  diathesis,  as  the 
technical  ex,  -ession  runr  ->  that  a  trifling  lesion 
would  produce  (in  the  sei  of  being  followed  by) 
excessive  hemorrhi  ,5je,  lon^  continued,  almost  impos- 
sible to  check,  coi'^'!  it  be  argued  that  the  diathesis 
vas  a  contributir"  r»use  to  the  continued  disabil- 
ity ?"  -.1  »ly  such  uv.ditions  of  the  body  are  condi- 
tions 01  ,  '^in  the  logical  sense  of  the  word)  and  not 
causes. 

The  appeal  should,  in  my  opinion,  be  dismissed 
with  costs." 

All  the  four  judges  of  the  highest  court  in  the 
Province  agreed  that,  while  medically  the  infection 
was  a  cause  of  the  disability,  it  should  not  be  con- 
sidered such  in  interpreting  such  a  contract. 

The  case  is  interesting  (if  for  no  other  reason) 
as  showing  that  even  courts  of  lav/,  conservative  as 
thej'  are  and  must  be,  cannot  avoid  taking  cog- 
nizance of  the  adv  ;nce  of  medical  science. 

Osgood  Hall. 


i 

If 


